Central Florida Foot & Ankle Center, LLC
101 6th Street N.W.
Winter Haven, FL 33881
Plyometrics is a form of exercise that is designed to improve muscular power, speed of contraction, and improve the response time of the neuromuscular system. It is typically used by competitive athletes as a form of cross-training, but recently has become more po pular in the non-professional athletic community. The technique involves combining muscle loading and fast contractions in order to improve muscle power. Muscle power includes not just strength of muscles (i.e., how much weight a person can lift) but also considers the speed at which that force is delivered.
In particular, plyometrics are used to strengthen and train the muscles and reflexes of the lower extremity, as well as improve core strength. Research has shown that the use of plyometrics in professional athletes has increased performance as well as decreased the incidence of injury.
Specific exercises include a variety of different lunge and squat techniques. The plyometric exercise consists of a fast elongation phase of contraction (eccentric phase) followed by an amortization or resting phase, which is then followed by a short burst contraction phase. For example, this may involve a quick squat, followed by a brief period of rest, followed by a jump off the ground.
The science behind plyometrics revolves around the specific muscle fibers being trained. The muscle fibers of the body consist of slow-twitch (type I), fast twitch type A (type IIA), and fast twitch type B (type IIB). In plyometrics, the fibers being worked are the fast-twitch fibers. Plyometrics also helps train the muscle reflexes that help control muscle contractions.
Plyometrics can be a excellent adjunct to an training or exercise program, but should only be undertaken by those in good physical condition. Because of the high impact nature of many of the exercises, those engaging in plyometrics should be ready for this impact. The technique used is of utmost importance, so as to avoid injury when training. Age is also a consideration, as many people of advanced age are advised against high impact activity due to arthiritis, osteoporosis, or other conditions that may jeopardize the safety of the individual.
There is not usually much equipment required for plyometrics. Generally a pair of sturdy training shoes designed for lateral movements, comfortable clothes, and enough space to move around is all that is needed. Many people follow instructional videos, or participate in organized classes that can help with technique. Plyometrics is an intense workout, so if you’re planning on trying it, be sure that it is safe by talking to your doctor about your new exercise plan. And bring plenty of water.
Hammertoes involve a contracture deformity at one or more of the joints in the toe. The most common deformity seen involves a flexion contracture at the proximal interphalangeal joint and an extension contracture at the distal interphalangeal joint. There are also isolated deformities of the distal interphalangeal joint known as mallet toe, and dual flexion contractures at the distal and proximal interphalangeal joints known as claw toes. A deformity may also be present at the metatarsophalangeal joint in any of these hammer digit variations.
Clinically, it is important for the evaluating physician to recognize if the deformity is flexible or rigid. Flexible deformities can be treated in some cases conservatively with orthotics, which serve to neutralize the deforming forces. Hammertoes are typically caused by a biomechanical abnormality that leads to a loss of muscle balance in the digits. Flexible hammertoes can also be treated surgically with a flexor tendon transfer or a simple flexor tenotomy.
For rigid deformities, conservative therapy involves accommodation and palliation. Corns that develop from the prominent joint rubbing against shoes can be shaved down, and corn pads and toe spacers can be used to make the person more comfortable. Wider and deeper shoes will also help for many.
Surgical correction of a rigid hammertoe can involve either an arthroplasty or an arthrodesis. Arthroplasty involves cutting some of the bone out of the joint, which creates a wider, more mobile joint. Arthrodesis is a fusion of the joint, which helps to straighten out the toe. The Smart Toe implant is a newer piece of hardware that helps in arthrodesis procedures.
The smart Toe device is placed in the two bones that create the joint, either at the proximal or distal interphalagenal joints of the digit. This allows for a fusion of the joint. The hardware is composed of metal that expands once placed into the body, and keeps a rigid fusion of the joint. They are kept frozen, and heat allows them to expand. Using a Smart Toe avoids having a pin coming out of the tip of the toe, which can potentially lead to infection or loss of correction at the joint.
Smart Toe comes in both straight models and in models that have a slight bend to them. The 10 degree bend allows for the tip of the toe to touch the ground easier, and provides a more natural looking correction. Smart Toe has become a popular option in the treatment of hammertoes by podiatrists, due to the ease of use and to patient satisfaction.
If you are considering treatment for hammertoes, talk to your provider about the different options, and which options would be best for you.
Corns and calluses of the feet are a common problem for many people. They develop because of repeated friction to the area. This may be the result of poorly fitting shoes, or biomechanical abnormalities that cause a person to put excessive pressure in one area of the foot. A corn develops on either the top or outside of the foot, while a callus develops on the bottom of the foot. Corns are usually in one particular area, such as on the tops of the toes, while calluses can be more diffusely located on the bottoms of the feet. A corn can also develop in between the toes as a result of the bones of the toes rubbing against each other and the skin between them becoming thickened. When this occurs, the corn is known as heloma molle.
A corn will appear as a thickened lesion, which may or may not be painful. Because of the increased friction to the area, the body's response is to increase skin production to protect the tissues below the skin. This is what causes the skin to thicken, become dry and flaky, and to often become elevated compared to the surrounding skin. Corns and calluses may become painful if they are neglected.
Generally, corns and calluses are not a huge problem. They can cause local discomfort, but will usually resolve quickly when the outside force causing increased pressure or friction is removed. This may be something as simple as changing a pair of ill-fitting shoes or using a small piece of padding in the area.
For diabetics and other people prone to peripheral neuropathy, corns and calluses can be more of a concern. Becuase of the loss of sensation to the feet in diabetic and other forms of peripheral neuropathy, a person may never feel the pain from increased friction and callus formation. Without feeling that pain, the skin can break down and an ulcer can form. When an ulcer forms, they can be very difficult to treat and rely on off-loading the area to remove unwanted pressure. Because of this concern, it is important for diabetics to check their feet daily, and to have their doctor or podiatrist inspect them as well.
Professional treatment may become necessary when corns and calluses become painful, particularly if it is difficult for one to care for their own feet. This would include elderly and diabetic populations, as well as those with chronic back pain and other conditions limiting mobility. Removing the callus with a scalpel blade is often a quick way to make a patient feel better. Treatment should also focus on removing the causative factor of corns and/or calluses. This may include padding, strapping, or orthotics. In some situations when a bony prominence may exist causing undue pressure and pain in the area, a small piece of the bone can be removed surgically to relieve the pressure.
The Achilles tendon, or tendo-Achilles, is a large, rope-like tendon that runs along the back of the leg and inserts into the calcaneus, or heel bone. The tendon is comprised of two muscles coming together, the gastrocnemius and the soleus. It is the longest tendon in the body, and functions to lift up the heel when the calf muscles contract. This is a vital function for activities such as walking, running, and jumping. When the calf muscles contract, the heel is pulled up, allowing us to point or toes. A complete tear through the tendon is known as a rupture, and most frequently occurs in the area 2-3 inches above the heel.
As a person ages, a tendon can become weak and thin. This underlying weakness of the Achilles tendon is typically present in a total rupture. Some medications such as corticosteroids or certain antibiotics, as well as illnesses such as arthritis or diabetes may also weaken the Achilles tendon.
Most frequently, Achilles tendon ruptures are seen in middle-aged male athletes. These “weekend warriors” will usually injure themselves during a sport that requires sudden bursts of activity, in particular racquet sports like tennis or squash, and basketball.
Symptoms of an Achilles tendon rupture are a sudden and severe pain in the back of the calf. There may be an audible popping or snapping sound when the tendon ruptures. Walking may still be possible, but strength of push-off with the toes will be weakened. Bruising and difficulty walking may follow the initial pain and swelling.
If you are exhibiting signs of an Achilles tendon injury, there are several tests that a doctor can perform in the office to determine the likeliness of a total rupture. The doctor may have you lie flat on your stomach, while they feel the back of your calf. A slight depression can often be felt where the tendon should be tight. Another test is to squeeze the calf muscles of the affected side. In a normal person, squeezing the calf will cause the foot to plantarflex, or point the toes. In someone with a total rupture of the Achilles tendon, this motion will be lost. A partial tear of the Achilles tendon will typically still cause the motion to occur, as some of the residual fibers are left intact.
An MRI or ultrasound may also be ordered in order to confirm the diagnosis. These imaging studies can show the foot and ankle surgeon whether or not the injury is a partial tear or complete rupture, and will help determine the extent of the injury.
Treating an Achilles tendon rupture can either be surgical or non-surgical. The non-surgical method involves placing the foot and ankle in a cast for 2-4 weeks, at which time the cast may be replaced. This allows the foot to be immobilized while the tissues heal. Casts are typically changes in order to allow slow stretching of the tendon so that it does not heal in a contracted position.
PRICE therapy also applies to Achilles tendon injuries. This involves protection (via a cast or brace), rest, ice, compression, and elevation to relieve some of the swelling.
Surgical treatment involves repairing the ruptured tendon by suturing it back together. Research has shown that in both competitive and non-competitive athletes, there is a decreased risk of re-rupture with surgical repair. There has also been some evidence to show that the time to recovery is faster using surgical repair than with non-surgical management. There are inherent risks involved with any type of surgery, however, including risks associated with anesthesia, infection, non-healing of wounds, scarring, bleeding, nerve injury, and blood clots developing in the legs.
Preventing Achilles tendon injuries, especially in older athletes, revolves around stretching the muscles before activity. This is a critical step in any workout, yet is often skipped over.
A Jones fracture is a fracture of the fifth metatarsal base. The pain will be located in the middle of the foot in the area of the fracture. A person who has sustained a Jones fracture will have pain and swelling in the area, and will typically have difficulty walking. In injury was first described in 1902 by Sir Robert Jones, a British orthopedist.
Jones fractures are diagnosed by using x-rays. The ordering physician will usually be able to see the fracture line through the fifth metatarsal. The fracture is located at the proximal end of the fifth metatarsal, through the diaphyisis. This is the long, tubular part of the bone.
Because of the location of a Jones fracute, they can often be difficult to heal. The area of bone that is fractured lies between the insertion point of two tendons. These tendons function to pull the bone in two different directions. When there is a fracture between theses two insertion points, that can lead to a lot of motion at the fracture site and therefore, prolonged healing time.
This area of bone also has a decreased blood supply when compared to the bone surrounding it. This is sometimes referred to as a watershed area in the medical community, meaning that the area of bone is not well vascularized, which can also lead to a longer time to heal.
In order to allow a Jones fracture to heal, the patient must be non weight-bearing for a minimum of four to eight weeks. However, due to the decreased vascularity and excessive motion caused by tendon insertion and muscles originating from the area, this is often not enough time for the fracture to heal. In some cases, it may take up to twenty weeks for the fracture to heal.
Surgery is often indicated for a Jones fracture. Reattaching the broken bone using pins, screws, or plates will frequently allow a stable fixation of the fracture. This stable fixation is key to the healing process. The prognosis for Jones fracture is greatly improved with the use of surgical correction.
Other fractures of the proximal fifth metatarsal include avulsion-type fractures as well as stress fractures. These types of fractures generally heal faster and more readily than the Jones fracture, partly because of where they occur in the bone. The areas of the bone affected by these other fractures are generally more protected by the tendons inserting in the area, and have a greater vascular supply. These types of cases typically will not require surgery, and will respond well to casting and immobilization.